Clinical risk management is a key area in terms of healthcare quality, especially within intensive-care settings and in the case of pediatric patients. The objective of this review is to assess the impact of tools for clinical risk management in pediatric intensive-care settings. Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology (June 2019). Primary studies of applicative experiences of clinical risk management that had impacts in pediatric intensive care units were included. A total of 1178 articles were reviewed and 20 were included. Reactive risk management tools were used in 10 studies; proactive tools in 7; both reactive and proactive tools in 3. Sixteen studies out of 20 concerned drugs; other topics included: transition from hospital to primary care, hand hygiene, organizational aspects, human milk administration. Seven studies (35%) reported organizational impacts; Ten studies (50%) reported clinical and organizational impacts; Three studies (15%) reported organizational, clinical and economic impacts. The introduction of clinical risk management tools resulted in changes within the setting considered; combined use of reactive and proactive methodologies was highlighted in various studies, as well as an increasing focus on proactive tools, both drawing a growing trend over time.